Haiti and the whole island Hispaniola are suffering the first cholera outbreak within almost 100 years. First case of cholera appeared on 19 October 2010. Initially, the majority of the cases were coming from the Artibonite river basin, between Mirebalais and St. Marc. On 21 October 2010, Cholera was confirmed by laboratory tests. The Artibonite river is likely to be the source of the outbreak.

All ten departments are now affected, with the departments of Artibonite, Nord, Nord-Ouest and Ouest and the city of Port-au-Prince most hit. As of 4 December, 20 cases of cholera have been detected in the neighboring Dominican Republic.

The number of hospital admissions had more or less stabilizing in the worst affected areas as well as the mortality rate (Artibonite, Port-au-Prince, Nord-Ouest, Centre). Still,high mortality in newly affected areas (Grande Anse, Sud-Est, Nord-Est).

As of December 3, 54 CTCs and 102 CTUs are now operational. It is estimated that the bed capacity of these centers is 4,681 and 1,222 respectively.However, there is still an urgent need for more Cholera Treatment Centers and Units (CTCs/CTUs), Oral Rehydration Posts (ORP), additional supplies and trained personnel for treatment. The capacity to scale up operations is the major challenge for all actors.

The official health system is overwhelmed with the fast growing number of new cases and the international cooperation, mainly MSF and the Cuban Brigades are coping with the case load.

Supplies, management and disposal of dead bodies and excreta and transport of patients are critical issues.

There is an urgent need for additional epidemiological support at the departmental level especially through mobile outreach teams.

Access to clean water is a major concern. The distribution of more water purification tablets, sachets of oral rehydration salts, chlorine powder for chlorination of water in priority areas is essential.

Adequate water and sanitation (biological waste management) within CTCs/CRUs has to be ensured as a priority. WASH experts are urgently needed.

DINEPA (Direction Nationale de l’Eau Potable et de l’Assainissement) is concerned about the need of hygiene promoters.

PAHO (Pan American Health Organisation) anticipate 400,000 symptomatic cases in the months to come. Effective provision of potable water and sanitation is the only way to reduce daily case load.

4. Main Challenges for international assistance

The present riots in Haiti are having serious consequences on the humanitarian aid operations in Haiti. People affected with cholera do not anymore have access to life-saving treatment, because widespread violence prevents cholera treatment centres from operating and medical personnel from moving around freely.

The violence is also preventing the delivery of clean water and other basic services, both to cholera affected communities and to the numerous tented camps which still house more than one million people affected by the 12 January earthquake.

The mortality figures are likely to rise dramatically the longer the current unrest goes on. The situation is particularly worrying in areas where the cholera attack and lethality rates are currently very high.

5. Commission's Humanitarian Response

European Commission Humanitarian Aid and Civil Protection Department (ECHO):has an office in Port-au-Prince.

ECHO is currently allocating up to 12 million in new contracts and extensions of existing contracts to humanitarian NGOs in the affected areas.

ECHO strategy is threefold :

Curative strategies: training of health staff, support of CTCs, CTUs and Oral Rehydration Points, referral system for patients, supply chain for medical products.

Preventive strategies: Intensification of existing services through partners: hygiene promotion (targeting at chlorination at the domestic and water point level, hand washing, disinfection of latrines in camps, information and communication on cholera), distribution of soaps, aquatabs and ORS, extension of chlorinated water trucking.

Support of epidemiological surveillance system and health coordination at the departmental level and in Port-au-Prince.

ECHO humanitarian partners' presence in Haiti

6. Commission's Civil Protection Response

DG ECHO deployed an EU civil protection (EUCP) team to Haiti from 24.11 on with duration of their mission of 3 weeks. The team is composed of three experts from Member States (Belgium, France and Sweden), one epidemiologist from the European Centre for Disease Prevention and Control (ECDC), two members from EUTAC Johanniter (Germany), providing communications, logistical support and technical assistance to the team, and one liaison officer from the MIC.

- liaising and cooperating with the authorities and other players on site, particularly with the World Health Organisation (WHO), DINEPA, COUN (Centre d'Opérations d'Urgence Nationale).

The team has contacted DINEPA and in close coordination is monitoring the situation. Main topics are: distribution drinking water; aquatabs and soaps, chlorination for bladders and water treatment units.

Part of the team performed a field mission together with DINEPA representatives in Artibonite (vallée du fleuve Artibonite) with the objective to identify suitable places for installing water purification units. Their assessment shows that every village visited along the ARTIBONITE river needs: 1. Latrines and waste treatment, 2. Water purification unit, in particular a system of “inverse osmosis” because of the brackish water, 3. Distribution system for the water from the unit to the target group.

A second field trip focused on medical issues was conducted in St Marc and Gonaives to visit the Cholera Treatment Centres and Cholera Treatment Units.

Austria offered 1,008.000 67mg Oasis Aqua-tabs (1 tab acts for 5- 10 litres). The offer was accepted by the Haitian water distribution authority (DINEPA - Direction Nationale de l’Eau Potable et de l’Assainissement). The cargo left for Haiti on the 6 December.

France delivered three tons of medicines and medical equipment, accepted by the University Hospital of Port-au-Prince. The assistance was transported on three flights on 24, 25 and 29 November.

Italy offered four Inter Agency Diarrheal Disease Kits (IDDK) as well as medical equipment and material for the treatment of cholera (11,6 tons of material). The offer was accepted by PAHO and is expected to arrive in PaP on 7 December.

Belgium has offered 2 water purification units 4 m3/h and 10 m3/h. EUCP team on site is working together with DINEPA to make proper arrangements for receive and install the units. Belgium will ask for transport support from the Commission and the assistance is expected to leave for PaP later this week.

7.Other Commission's services response

Experts from the European Centre for Disease Prevention and Control (ECDC) havebeen deployed since 13 November in Port-au-Prince as support to ECHO activities. This EU agency, which reports to DG SANCO, is specialised in communicable diseases and health risk assessment. They work in close collaboration with ECHO field team and will assess further needs and formulate a strategy for European support to the epidemiological surveillance system. In addition, ECDC has identified and facilitated the deployment of European experts in epidemiology and logistics to work with WHO/PAHO on field missions.

The objectives of the mission are to assess the needs for sub-sequent ECDC support teams in size, expertise and duration. These teams should include logistics such as accommodation, transport, office requirements, communication, security and finances.

The European Union Delegation in Port-au-Prince is supporting the provision of medical supplies through PAHO/PROMESS (Program for Essential Medicine and Supplies).

8.EU Member States response

On 10/12/2010

Commitments in 14pts

Cash

In-kind

Total

Pledges (2)

Total financial contributions

A

B

B

A + B

AUSTRIA

PM

BELGIUM

BULGARIA

CYPRUS

CZECH REPUBLIC

DENMARK

134.131 €

134.131 €

134.131 €

ESTONIA

FINLAND

800.000 €

800.000 €

800.000 €

FRANCE (1)

331.500 €

65.000 €

396.500 €

396.500 €

GERMANY

826.500 €

826.500 €

826.500 €

GREECE

HUNGARY

IRELAND

PM

ITALY

100.000 €

100.000 €

100.000 €

LATVIA

LITHUANIA

LUXEMBURG

67.511 €

67.511 €

67.511 €

MALTA

NETHERLANDS

500.000 €

500.000 €

500.000 €

POLAND

PORTUGAL

ROMANIA

SLOVAK REPUBLIC

SLOVENIA

SPAIN

2.500.000 €

140.000 €

2.640.000 €

2.640.000 €

SWEDEN (2)

2.827.582 €

2.827.582 €

3.300.330 €

6.127.912 €

UNITED KINGDOM

5.822.292 €

5.822.292 €

5.822.292 €

TOTAL

13.909.516 €

205.000 €

14.114.516 €

3.300.330 €

17.414.846 €

(1) €331,500 (cash and in-kind): cholera outbreak + hurricane Tomas

(2) cash: of which €2,214,326 for cholera outbreak and hurricane Tomas